The mood in New South Wales State Supreme Court was somber that early June day in 2009. Seven years earlier a little girl of nine-months from Earlwood, Sydney, had died under tragic circumstances, and in the dock for medical negligence were her Indian immigrant parents, Mrs. Manju and Thomas Sam. The jury heard, from experts and other witnesses, how baby Gloria Thomas suffered from significant malnutrition early in her short life, which compromised her immunity; how she was diagnosed with eczema at four months, and through her broken skin, disease-causing bacteria entered her bloodstream, attacking her lungs and one eye; and how throughout the entire, extremely painful ordeal, her father—a homeopath—steadfastly, repeatedly refused medical care, electing instead to treat her with one homeopathic remedy after another, until she passed away. The jury returned a verdict of manslaughter, and the judge sentenced the couple to up to 8 years in prison.
Belief in homeopathy can run the entire gamut from the tragic to the frankly bizarre. When Bethan Jinkinson, a BBC journalist, took her 11-month-old daughter Kira to Dr. Michelle Langdon, a family doctor in Camden, North London in 2000, after the toddler had a severe bout of vomiting, Jinkinson was hardly expecting to hear that her child’s illness was linked to ‘geographic fault lines’ passing under their house. Nor did she suspect that Langdon would whip out a crystal pendant and swing it “over a book of herbal remedies”—apparently to divine a treatment for Kira, eventually suggesting homeopathic phosphorus. Thankfully, Jinkinson whisked her daughter away to London’s University College Hospital, where she was diagnosed with acute gastroenteritis and adequately treated. Langdon, who abdicated her responsibility to patients as a physician and followed her belief in homeopathy, was cited in 2003 for professional misconduct and given a 3-month practice ban.
What is pseudoscience?
I asked Edzard Ernst, Professor Emeritus of Complementary Medicine at University of Exeter, UK, this very question. And who better to define it? Ernst, who had trained in various alternative-medicine modalities—including homeopathy—early in his clinical career, dedicated his later research endeavors to bring scientific empiricism and evidence-based scrutiny to the practice of alternative-medicine, much to the consternation of its practitioners. Opined Ernst via email, “Pseudoscience is a poor imitation of science that can cause harm to people who fall for it by misleading them to take wrong decisions that may not be in their best interest.”
Homeopathy fits that bill perfectly.
It is not hard to find tragic examples, where belief in homeopathic remedies brought hapless patients—both children and adults—to grievous harm. Which begs the question: why does homeopathy enjoy an abiding popularity in many nations across Europe, Latin America, Africa, the Mediterranean, the Mid-East and Asia? In the US, a $30 billion homeopathy and herbal therapy industry is patronized by nearly 1 in 5 adults, according to the latest data available (2012 National Health Interview Survey).[4-9]
The answer is not straightforward. Belief in alternative-medicine—with a concordant distrust in conventional medicine—is often culturally-driven. Thomas Sam’s belief in homeopathy was imprinted in India, where this alternative-therapy system enjoys governmental patronage and nearly equal status as medicine. In my own family, belief in homeopathy meant that I, as a child, would be seen by physicians who—much like Langdon—practised homeopathy along with medicine.
In retrospect, my parents’ faith was likely more in the physicians than the actual therapy offered. Studies show that a friendly, reassuring physician begets more positive health outcomes in their patients; even for common cold, physician empathy was associated with positive, disease-modifying effects. The perception of medical professionals as uncaring and peremptory, and homeopaths as gentle healers with ‘nature-based’ remedies—popularized via media portrayals, testimonials, and celebrity endorsements—dovetails nicely with a narrative which bolsters the image of greedy, grubby-pawed pharmaceutical companies who produce expensive, artificial medications riddled with side-effects—while conveniently overlooking the multi-billion-dollar alternative therapy and supplement industry.[11-13]
But… does it work?
Beyond physician empathy, do homeopathic remedies actually work? A wealth of empirical evidence—in form of analyzed data from clinical studies comparing homeopathy to regular medications or inactive ‘placebos’—says, ‘No.’
In 2005, Aijing Shang and colleagues analytically compared large, high quality, placebo-controlled trials in homeopathy and conventional medicine, and demonstrated that, unlike medicine, homeopathy had no demonstrable differences from placebo outcomes. Since then, multiple governmental agencies—in the UK, Australia, and the EU—undertook large scale, exhaustive systematic reviews and rigorous meta-analyses of available research data on homeopathy, and evaluated anecdotal evidence as well. Notably, all of them concluded some variation of “There’s little evidence to support homeopathy as an effective treatment for any specific health condition.” This, incidentally, is what is categorically stated in the website of NCCIH (National Center for Complementary and Integrative Health), a US-government agency expressly established to promote research in alternative-medicine.[14-18]
Relatively recent analyses performed by homeopathy researchers have, perhaps unwittingly, also shown similar outcomes; even for largely self-correcting conditions—such as vertigo and seasonal allergic rhinitis—when compared with medications conventionally used for symptomatic relief, homeopathy offered no additional clinical benefit.[19-21]
These conclusions make sense in the light of ‘prior plausibility’—a concept that demarcates science from pseudoscience—which homeopathy lacks. Science advocate Harriet Hall, a former US Air Force physician, once illustrated this concept with a brilliant neologism “Tooth Fairy Science.”
You could measure how much money the Tooth Fairy leaves under the pillow, whether she leaves more cash for the first or last tooth, whether the payoff is greater if you leave the tooth in a plastic baggie versus wrapped in Kleenex. You can get all kinds of good data that is reproducible and statistically significant. Yes, you have learned something. But you haven’t learned what you think you’ve learned, because you haven’t bothered to establish whether the Tooth Fairy really exists.
Classical Homeopathy—built around unscientific, spiritual beliefs of its founder Samuel Hahnemann (1755-1843)—is the perfect example of Tooth Fairy Science. Homeopathic remedies are serially diluted, by factors of 10 or 100, from the starting material (alcoholic extract of some plant or animal substance, or a chemical such as salts); the dilutions are repeated 30, 200, 1000 or more times. At these dilution levels, it is implausible—from what we understand of the fundamental laws of physics (which guide all matter in the known universe)—that the solution will contain even a single atom or molecule of the initial substance.[16, 23, 24]
To make matters weirder, homeopaths claim extraordinary efficacy against a variety of diseases for these highly diluted preparations, while reconciling such claims by asserting—with no satisfactory evidence—that these high dilutions, sans any actual substance, work by ‘preserving a memory of the original substance’ used at the beginning of the dilution series.[25-29]
Despite tremendous advances, modern medicine—with its empirical rigor, and iterative, evidence-based approach—cannot claim to have all the answers related to disorders and diseases. This unmet need is a void which homeopathy, unbound by empiricism and requirement for evidence, steps in to fill. After all, what is the harm if homeopathy provides succor to desperate, scared patients?
Administration of inactive therapies to patients is an ethically suspect practice, as is making unproven medical claims. Contrary to homeopathy’s image as ‘inexpensive’, homeo-interventions may be associated with higher long-term costs. But perhaps the most intangible harm is wrought by the waste of time consulting with homeopaths, which delays a proper medical diagnosis, thereby worsening the disease course. Inadequately regulated manufacturing practices pose additional risks; hundreds of infants and toddlers suffered severe adverse reactions from certain homeopathic teething tablets/gels containing belladonna—a toxic alkaloid from the herb Deadly Nightshade—prompting US FDA to issue a warning.[30-37]
Recently, many homeopaths have been advocating ‘nosodes’—a type of remedy prepared by the typical homeopathic dilution of biological material, such as body fluids or tissue, obtained from an animal or human afflicted with some infectious disease. Homeopaths claim clinical efficacy of homeopathic nosodes in preventing a variety of infectious diseases, and often project these remedies as ‘vaccine-alternatives’ for children; however, so far there is no good quality evidence supporting such claims, and peddling of nosodes bodes ill for public health and disease prevention efforts.[24, 38, 39]
Patients are often influenced by medically-unqualified individuals amongst family, friends, and acquaintances, when choosing homeopathy.[40-42] Therefore, providing patients with scientifically accurate information is likely the key to countering harms of pseudoscience. Physicians, science advocates and journalists, please take note.
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